TCA Insurance Page

Insurance / Payment Information

This page collects your insurance or payment information so that we may check your benefits and let you know about your costs as soon as possible. After pressing submit, you will be taken to the booking calendar where you can make a 10 minute phone appointment with our intake coordinator. She will help you find the right therapist. There is no charge for the appointment with the coordinator. Please contact us during office hours (M-F, 9-6) if you need additional assistance. - 617-286-6513.
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Insurance Company or Enter Self Pay ($150 first session; $135 thereafter)*
Insurance Subscriber ID or Enter Self Pay*
Insurance Phone Number (see back of card) or Enter Self Pay*
Pressing submit will take you to a third party site, called BREEZE, where you will be able to request an appointment time with our Intake Coordinator.
Should be Empty:

Insurance / Payment Information